In collaboration with Dr. Eleonora Roncarati
The struggle between food and body, between nature and culture, brings together various ailments; the most studied are the Eating Disorders (DCA), such as anorexia, bulimia and binge eating disorder, but recently another psychopathology is spreading which mainly affects the male sex and which has several elements in common with the aforementioned disorders: it is muscle dysmorphism or bigorexia or inverse anorexia.
The element that unites these disorders is the obsessive attention to one's own body image which, however, is perceived in a distorted way (bodily despair). However, it should be emphasized that muscle dysmorphism does not belong to the group of DCA [in the Diagnostic Statistical Manual IV ° edition (DSM IV °), DCA and Body Dysmorphic Disorder are treated as different psychopathologies], but represents a different psychopathology, in which what arouses concern and discomfort is not the whole body (the entire physical form), but a specific part (nose, mouth, arms, muscle mass etc.) or even a physiological reaction (blushing, sweating, etc.), which is perceived as excessive or defective; furthermore, the concern may concern several districts simultaneously.
The construction of the image becomes a project, a goal and a constant practice, in which the focus on the body (or on certain parts of it) and the search for muscularity (closely linked to dissatisfaction with one's appearance) are risk factors fundamental but not sufficient for the development of muscle dysmorphism.
Diagnostic Criteria for Body Dysmorphic Disorder
- Concern about a supposed defect in physical appearance; if a small anomaly is present, the importance that the person gives it is far too much.
- The worry causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The worry is no longer attributable to another mental disorder (dissatisfaction with body shape and measurements in anorexia nervosa).
The DSM-VI specifies that:
- The essential feature of Body Dysmorphic Disorder is concern for a defect in physical appearance (criterion A). The defect can be imaginary or, if a small physical abnormality is present, the concern of the subject is far excessive.
These defects can concern: face, head, more or less thick hair, acne, paleness or redness, sweating, asymmetries or disproportions of the face or excessive hair. Other common concerns include the shape, size or some other aspect of the nose, mouth, eyes, ears, teeth, jaw. However, any other part of the body can become a cause for concern (legs, belly, hips, arms etc ...), as well as overall body measurements, build and muscle mass.
- Unlike normal concerns about physical appearance, concern about physical appearance in body dysmorphism is too time consuming, and is associated with significant distress or impairment in social, occupational, or other important areas of functioning (criterion B).
People with this disorder therefore feel great discomfort from their supposed deformity, often describing their worries as "intensely painful", "tormenting" or "devastating". Their worries are so difficult to control that they often cannot resist them; as a result they spend many hours a day thinking about their "defect", to the point that these thoughts can dominate their life. In addition to "thinking", frequent checking of the defect occurs frequently, either directly or through a reflective surface (mirror, shop windows, etc.).
These feelings of conscious shame can lead to avoiding situations of work, school or social contact with consequent: social isolation, abandonment of school and work or avoiding job interviews or working below one's potential.
- People with this disorder tend to compare the "ugly" part of their body with that of others.
- There may be frequent requests for reassurance about the defect, which however bring only temporary relief.
- Behaviors that aim to improve the defect include exercise (e.g. weight lifting) and diet. Physical exercise associated with dysmorphism is excessive and compulsive, therefore different from healthy exercise: men with body dysmorphism exercise compulsively in order to increase muscle mass but the image they see in the mirror is never satisfactory.
It is possible to say that even in males, dissatisfaction with one's physical appearance can encourage unhealthy behaviors (such as resorting to inappropriate diets, excessive and compulsive exercise, abuse of supplements or steroids) but in itself it is not a symptom of psychiatric interest. ; it becomes pathological when the subject comes to an absolute conviction of his own deformity, perceived as so evident that it cannot arouse in others but disgust and derision.
The ensuing anxiety and worry lead to a disorder of social functioning (ie great difficulty in social relationships). [Reference text: Body Building. Athletes fighting with the body. Doping, sport and muscle dysmorphophobia]
Bibliography:
- ANTIBODIES. Diet, fitness and other prisons - Luisa Stagi - Franco Angeli, Milan, 2008.
- Body Building. Athletes fighting with the body. Doping, sport and muscle dysmorphophobia - Sofia Tavella -Quattroventi, Urbino 2008.
- DSM IV-TR Diagnostic and Statistical Manual of Mental Disorders; Fourth Edition, Text revision - Washington, DC, American Psychiatric Association, 2000.
